Abstract
In a recent brief to the Canadian Nurses Association's National Expert Commission on the Health of Our Nation, the Academy of Canadian Executive Nurses (ACEN) discussed leadership needs in the Canadian healthcare system, and promoted the pivotal role of nursing executives in transforming Canada's healthcare system into an integrated patient-centric system. Included among several recommendations was the need to develop innovative leadership competencies that enable nurse leaders to lead and advance transformative health system change.
This paper focuses on an emerging "avant-garde executive leadership competency" recommended for today's health leaders to guide health system transformation. Specifically, this competency is articulated as "state of the art communication and technology savvy," and it implies linkages between nursing informatics competencies and transformational leadership roles for nurse executive. The authors of this paper propose that distinct nursing informatics competencies are required to augment traditional executive skills to support transformational outcomes of safe, integrated, high-quality care delivery through knowledge-driven care. International trends involving nursing informatics competencies and the evolution of new corporate informatics roles, such as chief nursing informatics officers (CNIOs), are demonstrating value and advanced transformational leadership as nursing executive roles that are informed by clinical data.
Background
The first decade of the 21st century provided compelling evidence supporting the need for transformative leadership in healthcare. National and international groundbreaking reports urge nurses and the nursing profession to contribute proactively through leadership roles (Harris and Murphy 2011; Institute of Medicine and Robert Johnson Wood Foundation 2010; Amara et al. 2000; Kirby 2002; Romanow 2002). Specifically, Amara's (2000) report recommended that eHealth transformational agendas recognize and position nurses as the most qualified to respond to the current changes in our health system. With the intent of eHealth goals to deliver better healthcare that is patient focused, results driven, integrated and sustainable, achieving these goals is critically dependent upon information and information technology. Nursing skill sets continue to align naturally in an environment (i.e., the health system) that is moving towards outpatient care and requires providers to function as teams and assume management roles in facilitating care across the continuum (CNA 2009; Remus 2006; Amara et al. 2000). The authors believe nurses remain most qualified, and well positioned as the largest contributors of healthcare services across all sectors, to support essential clinical transformation efforts through uptake of automated clinical tools (i.e., electronic health/patient records) that will result in new care delivery models.
Recent consultations by the Canadian Nurses Association (2012) advanced this discussion, noting that information must be utilized both as a tool to inform decisions and as an essential element in a preferred future reflecting an informed, effective and sustainable healthcare system. Concurrently, nurse leaders are recognizing that traditional skill sets (i.e., financial, resource management, clinical operations and so on) must be augmented with new skills that enable effective information utilization and management, and support the future-oriented strategic activity inherent in transformational leadership (Meyer et al. 2011). Nurse leaders who equip themselves with new nursing informatics management skills (i.e., information management competency) will be well positioned to reap the benefits that electronic health records (EHRs) offer. Further, those who move their transformative practice agendas forward through successfully leveraging EHRs will make informed, timely decisions that are knowledge driven, creating sustainable healthcare delivery across all nursing settings.
Fostering the Development of Transformational Nurse Leaders
NI competencies: Essential skills for nurse leaders
The Academy of Canadian Executive Nurses (ACEN) (Meyer et al. 2011) suggests that the timing is right and sets the imperative for Canadian nurse leaders to support emerging competencies that will enable health system transformation. Meyer and colleagues (2011: 25) endorse "state of the art communication and information technology savvy" as recommended leadership competencies. They also recognize the value of technology through competency in communication and information technology. However, the authors of this paper propose that this competency, as stated, underestimates the meaning or appreciation of requisite nursing informatics (NI) competencies and does not fully convey the scope or intensity of effort that nurse leaders will need to invest in such competencies. Instead, we recommend explicit articulation of these distinct informatics skills, defining competencies unambiguously with measureable knowledge dimensions and clear outcomes of application supporting avant-garde leadership (Kennedy and Remus 2012b).
NI competencies are not necessarily new. The American Nurses Association in 2001 was one of the first nursing professional bodies to endorse NI through a formal certification program and a published NI scope and standards of practice (ANA 2008).
NI competencies are increasingly recognized as a new essential skill set, enabling contemporary nurse executives to support and advance healthcare system transformation evidenced by a number of nursing and health professional associations that endorse NI and health informatics competencies (ANA 2008; TIGER 2006; COACH 2009; HIMSS 2012). Understanding the distinction between generic health informatics competencies and NI competencies is necessary for all nursing executives to recognize points of alignment, but also the points where nursing is unique and specifically requires a nursing perspective. COACH (2009: 7) defines health informatics as the "intersection of clinical, IM/IT [information management/information technology] and management practices to achieve better health." Nursing informatics, as a specialty practice within nursing and as a profession-specific specialty of health informatics, is defined by the International Medical Informatics Association (2009: 4) as "integrating nursing, its information and knowledge, and their management with information and communication technologies to promote the health of people, families and communities worldwide." In Canada, nursing informatics as a practice subspecialty is visible across all clinical nursing specialties, such as cardiology, paediatrics, respiratory, critical and peri-operative care, and more. NI is a foundational skill set regardless of the clinical specialty or role (e.g., executive, educator, researcher, clinical staff) because each of these roles relies on data/information to inform decisions on a daily basis.
COACH (2010: 25) recommends that health informatics leaders must understand "data context, terminology, privacy, data management and quality as well as the transformation of data into information to support decision making across the health care enterprise." Extrapolating this same breadth of knowledge is essential to nurse leaders, who must integrate these competencies into executive nursing roles to advance clinical information management and ensure the integration of NI competencies in health system reform activities. In doing so, nurses and the broader profession of nursing can improve both quality and continuity of care across the continuum by successfully leveraging information and communication technologies (ICTs), demonstrating evidence-based practices and gaining recognition as sophisticated knowledge workers. Nagle's 2008 vision challenges nurse leaders to move forward from an era of Luddites and become luminaries, guiding the profession and leading transformational eHealth agendas.
Recent reports, publications and recruitment trends illustrate how leading healthcare organizations are recognizing the value of nursing informatics competencies (Manos 2012; Murphy 2011; Harrington 2011, 2012; Harris and Murphy 2011; Simpson 2011). Catholic Healthcare Initiatives (Alfano et al. 2012), a large US multisite healthcare provider (32 healthcare organizations spanning 19 states), has created a strategic, systemwide chief nursing informatics technology officer role. This role is structured as a dyad with a systemwide chief medical informatics technology officer role and supports six tactical/regional chief nursing informatics officers (CNIOs) partnered with six regional chief medical informatics officers (CMIOs). Linda Hodges (cited in Manos 2012), an executive recruiter, reports that the recruitment of CNIOs is on the rise as a result of academic health science institutions' and large integrated health systems' placing value on NI skills and knowledge to facilitate meeting "accountable care organization" (ACO) mandates. Further, Manos (2012) has reported on other health and health-related organizations that are advocating for NI competencies and executive CNIO roles (e.g., Veterans Affairs, IT vendors and policy makers, among others).
Organizations that recruit nursing informatics leadership roles support the integration of NI competencies as an essential specialty role within nursing and healthcare leadership and believe that this contemporary approach will achieve two important goals. First, this approach will help protect healthcare system sustainability through information-informed decisions, and secondly, it supports achievement of the ultimate vision of healthcare – that of knowledge-driven care grounded firmly in outcomes and efficiency (Manos 2012; Currie 2011; Kimmel 2012; Pringle and Nagle 2009; Mays et al. 2008; Nagle 2005). Matney and colleagues' (2011) investigation into the NI data–information–knowledge–wisdom fram
Abstract
In a recent brief to the Canadian Nurses Association's National Expert Commission on the Health of Our Nation, the Academy of Canadian Executive Nurses (ACEN) discussed leadership needs in the Canadian healthcare system, and promoted the pivotal role of nursing executives in transforming Canada's healthcare system into an integrated patient-centric system. Included among several recommendations was the need to develop innovative leadership competencies that enable nurse leaders to lead and advance transformative health system change.
This paper focuses on an emerging "avant-garde executive leadership competency" recommended for today's health leaders to guide health system transformation. Specifically, this competency is articulated as "state of the art communication and technology savvy," and it implies linkages between nursing informatics competencies and transformational leadership roles for nurse executive. The authors of this paper propose that distinct nursing informatics competencies are required to augment traditional executive skills to support transformational outcomes of safe, integrated, high-quality care delivery through knowledge-driven care. International trends involving nursing informatics competencies and the evolution of new corporate informatics roles, such as chief nursing informatics officers (CNIOs), are demonstrating value and advanced transformational leadership as nursing executive roles that are informed by clinical data.
Background
The first decade of the 21st century provided compelling evidence supporting the need for transformative leadership in healthcare. National and international groundbreaking reports urge nurses and the nursing profession to contribute proactively through leadership roles (Harris and Murphy 2011; Institute of Medicine and Robert Johnson Wood Foundation 2010; Amara et al. 2000; Kirby 2002; Romanow 2002). Specifically, Amara's (2000) report recommended that eHealth transformational agendas recognize and position nurses as the most qualified to respond to the current changes in our health system. With the intent of eHealth goals to deliver better healthcare that is patient focused, results driven, integrated and sustainable, achieving these goals is critically dependent upon information and information technology. Nursing skill sets continue to align naturally in an environment (i.e., the health system) that is moving towards outpatient care and requires providers to function as teams and assume management roles in facilitating care across the continuum (CNA 2009; Remus 2006; Amara et al. 2000). The authors believe nurses remain most qualified, and well positioned as the largest contributors of healthcare services across all sectors, to support essential clinical transformation efforts through uptake of automated clinical tools (i.e., electronic health/patient records) that will result in new care delivery models.
Recent consultations by the Canadian Nurses Association (2012) advanced this discussion, noting that information must be utilized both as a tool to inform decisions and as an essential element in a preferred future reflecting an informed, effective and sustainable healthcare system. Concurrently, nurse leaders are recognizing that traditional skill sets (i.e., financial, resource management, clinical operations and so on) must be augmented with new skills that enable effective information utilization and management, and support the future-oriented strategic activity inherent in transformational leadership (Meyer et al. 2011). Nurse leaders who equip themselves with new nursing informatics management skills (i.e., information management competency) will be well positioned to reap the benefits that electronic health records (EHRs) offer. Further, those who move their transformative practice agendas forward through successfully leveraging EHRs will make informed, timely decisions that are knowledge driven, creating sustainable healthcare delivery across all nursing settings.
Fostering the Development of Transformational Nurse Leaders
NI competencies: Essential skills for nurse leaders
The Academy of Canadian Executive Nurses (ACEN) (Meyer et al. 2011) suggests that the timing is right and sets the imperative for Canadian nurse leaders to support emerging competencies that will enable health system transformation. Meyer and colleagues (2011: 25) endorse "state of the art communication and information technology savvy" as recommended leadership competencies. They also recognize the value of technology through competency in communication and information technology. However, the authors of this paper propose that this competency, as stated, underestimates the meaning or appreciation of requisite nursing informatics (NI) competencies and does not fully convey the scope or intensity of effort that nurse leaders will need to invest in such competencies. Instead, we recommend explicit articulation of these distinct informatics skills, defining competencies unambiguously with measureable knowledge dimensions and clear outcomes of application supporting avant-garde leadership (Kennedy and Remus 2012b).
NI competencies are not necessarily new. The American Nurses Association in 2001 was one of the first nursing professional bodies to endorse NI through a formal certification program and a published NI scope and standards of practice (ANA 2008).
NI competencies are increasingly recognized as a new essential skill set, enabling contemporary nurse executives to support and advance healthcare system transformation evidenced by a number of nursing and health professional associations that endorse NI and health informatics competencies (ANA 2008; TIGER 2006; COACH 2009; HIMSS 2012). Understanding the distinction between generic health informatics competencies and NI competencies is necessary for all nursing executives to recognize points of alignment, but also the points where nursing is unique and specifically requires a nursing perspective. COACH (2009: 7) defines health informatics as the "intersection of clinical, IM/IT [information management/information technology] and management practices to achieve better health." Nursing informatics, as a specialty practice within nursing and as a profession-specific specialty of health informatics, is defined by the International Medical Informatics Association (2009: 4) as "integrating nursing, its information and knowledge, and their management with information and communication technologies to promote the health of people, families and communities worldwide." In Canada, nursing informatics as a practice subspecialty is visible across all clinical nursing specialties, such as cardiology, paediatrics, respiratory, critical and peri-operative care, and more. NI is a foundational skill set regardless of the clinical specialty or role (e.g., executive, educator, researcher, clinical staff) because each of these roles relies on data/information to inform decisions on a daily basis.
COACH (2010: 25) recommends that health informatics leaders must understand "data context, terminology, privacy, data management and quality as well as the transformation of data into information to support decision making across the health care enterprise." Extrapolating this same breadth of knowledge is essential to nurse leaders, who must integrate these competencies into executive nursing roles to advance clinical information management and ensure the integration of NI competencies in health system reform activities. In doing so, nurses and the broader profession of nursing can improve both quality and continuity of care across the continuum by successfully leveraging information and communication technologies (ICTs), demonstrating evidence-based practices and gaining recognition as sophisticated knowledge workers. Nagle's 2008 vision challenges nurse leaders to move forward from an era of Luddites and become luminaries, guiding the profession and leading transformational eHealth agendas.
Recent reports, publications and recruitment trends illustrate how leading healthcare organizations are recognizing the value of nursing informatics competencies (Manos 2012; Murphy 2011; Harrington 2011, 2012; Harris and Murphy 2011; Simpson 2011). Catholic Healthcare Initiatives (Alfano et al. 2012), a large US multisite healthcare provider (32 healthcare organizations spanning 19 states), has created a strategic, systemwide chief nursing informatics technology officer role. This role is structured as a dyad with a systemwide chief medical informatics technology officer role and supports six tactical/regional chief nursing informatics officers (CNIOs) partnered with six regional chief medical informatics officers (CMIOs). Linda Hodges (cited in Manos 2012), an executive recruiter, reports that the recruitment of CNIOs is on the rise as a result of academic health science institutions' and large integrated health systems' placing value on NI skills and knowledge to facilitate meeting "accountable care organization" (ACO) mandates. Further, Manos (2012) has reported on other health and health-related organizations that are advocating for NI competencies and executive CNIO roles (e.g., Veterans Affairs, IT vendors and policy makers, among others).
Organizations that recruit nursing informatics leadership roles support the integration of NI competencies as an essential specialty role within nursing and healthcare leadership and believe that this contemporary approach will achieve two important goals. First, this approach will help protect healthcare system sustainability through information-informed decisions, and secondly, it supports achievement of the ultimate vision of healthcare – that of knowledge-driven care grounded firmly in outcomes and efficiency (Manos 2012; Currie 2011; Kimmel 2012; Pringle and Nagle 2009; Mays et al. 2008; Nagle 2005). Matney and colleagues' (2011) investigation into the NI data–information–knowledge–wisdom fram
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